Healthcare Provider Details

I. General information

NPI: 1972770956
Provider Name (Legal Business Name): NOVI PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26850 PROVIDENCE PKWY 455
NOVI MI
48374-1209
US

IV. Provider business mailing address

26850 PROVIDENCE PKWY 455
NOVI MI
48374-1209
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-4847
  • Fax: 248-465-4477
Mailing address:
  • Phone: 248-465-4847
  • Fax: 248-465-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MANISHA RAJUL PARIKH
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 248-465-4847